Hazelden Closing Speaks to Dilemma in Youth Treatment
Originally published in Alcoholism & Drug Abuse Weekly 14(24):1, 5-6, 2002
Introduction
This month's announcement that the nationally renowned Hazelden Foundation will discontinue its adolescent outpatient recovery services in and around Chicago offers further evidence of what many addiction treatment experts call the erosion of a continuum of care for youths.
Outpatient services that were once considered merely the front door to more intensive treatment for the troubled youth have become the standard for treatment under managed care. Faced with payors who they say dismiss adolescent substance-using behavior as a "phase," providers of adolescent services are left with a disconcerting choice: stay with treatment options that are reimbursable but may not be clinically effective, or find other ways to pay for more-intensive services.
The Hazelden Chicago staff has ultimately found neither option to be sustainable. It announced earlier this month that it would cease offering adolescent outpatient services in Chicago, and also would close suburban operations in the communities of Deerfield and Lombard in mid-August.
Peter Palanca, regional vice president and executive director at Hazelden Chicago, told ADAW that the Deerfield facility had served about 200 families since 2000, while the Lombard site had served about 550 families since 1998. But Palanca, who has developed adolescent treatment programs since the 1970s, said it has become increasingly difficult in recent years to sustain adolescent outpatient services, in an environment where youths with multiple needs cannot access more-intensive care.
"Just getting them to stay sober in an outpatient environment is very challenging," Palanca said. "You expect them to show up for as many days as your program is, but their parents won't let them use the car because they haven't shown that they're responsible enough."
From its facility in Chicago, Hazelden Chicago will continue to serve clients 18 and older. For area adolescents in need of intensive treatment, Hazelden Chicago will facilitate referrals to the Hazelden Center for Youth and Families in Plymouth, Minn. (Youths 14 and older will still be able to receive assessments at Hazelden Chicago.)
Palanca expects there will be an increase in the number of clients being sent to Minnesota from the Chicago area for treatment. The downside, he said, is services will be restricted to those whose families are able to pay for the care.
Fight or Switch?
Palanca said that for a youth who is engaging in heavy substance use and is facing a myriad of pressures in school and at home, residential treatment holds the best hope for meeting all the needs. Unfortunately, he said, "There are very, very few primary residential programs. It's a function of reimbursement."
Nevertheless, Palanca said Hazelden Chicago staff believed they had begun making good progress with youths in the outpatient setting. Clients were doing better in school; some were maintaining after-school jobs. But with Hazelden not receiving public funds, it was finding it difficult to maintain the outpatient services through donor activity.
United Way support for human services in the Chicago area has been down by about one-quarter in recent months, leaving organizations such as Hazelden Chicago even more dependent on philanthropy from individuals.
"You can only ask so many people for so much money to offset deficits with your adolescent programs," Palanca said.
For some time, Hazelden Chicago tried to modify its approach to treatment to suit current marketplace realities. But that's not the strategy every addiction treatment provider is employing. The nationally known Caron Foundation, based in eastern Pennsylvania, has committed to maintaining a continuum of adolescent treatment by relying on a combination of self-pay, out-of-network benefits and aggressive fundraising on behalf of families that can't pay.
"You can either be in bed with managed care and say you'll take what you can get, or you can do what we do, which is to say that we need at least three months to treat these adolescents," said David Rosenker, Caron's vice president of adolescent services.
Douglas Tieman, Caron's president and chief executive, said that Caron considers outpatient treatment as the conduit to more-intensive services for youths, and on the other end of the continuum as a pathway toward adjusting to life in the community. The organization is planning to open a New York City adolescent recovery center designed to be a catalyst to moving youths into residential treatment in Pennsylvania and then back into the community.
"We even struggled with whether to call these services 'outpatient services,' Tieman told ADAW. "We see this as a way to get youths into the system. This gives the family alternatives."
Rosenker, who this month participated in the first Ben Franklin Institute Summit for Clinical Excellence that was devoted to adolescent treatment, told ADAW that he believes Caron's approach is replicable for other facilities. To make it work, you need resources, a commitment from the board of directors, hard work from staff, and community buy-in, he said.
Adds Tieman, referring to one of his favorite subjects in addiction treatment program management, "You've got to be prepared to aggressively fund-raise."
Ongoing Problem
The president and chief executive of the National Association of Addiction Treatment Providers (NAATP) hears about Hazelden Chicago's dilemma and says it reflects an all-too-familiar pattern.
"We've never even reached the same level of understanding with managed care about adolescent treatment as we have with adult treatment," Hunsicker told ADAW. "Managed care wants to view adolescence as an experimental stage. What is reported as addiction, managed care tends to see as experimentation."
Tieman adds that this philosophy reinforces family members' denial that the youth has a problem that requires intensive services. "Parents want to believe that this is a rite of passage, or anything but a real problem," Tieman said.
Public systems of care seem to have a better handle on how appropriate interventions for youth can avert bigger problems later on, Hunsicker said. For providers that don't receive public funds, he said, fundraising can fill some gaps, but that strategy generally works better for capital financing than for ongoing program support.
But the Caron Foundation presses on in its effort not to play by managed care's rules. Tieman says Caron will not contract with any entity that restricts lengths of stay and thus limits youths' access to effective services.
He says that strategy is paying off. Only 14 percent of Caron's adolescent clients last month were self-pay clients; that figure is usually in the 25 to 30 percent range. "We're effectively using scholarship money," he said.
